Provider Demographics
NPI:1568539930
Name:ADVANCED CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-527-2225
Mailing Address - Street 1:114 FREELAND LN STE I
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1615
Mailing Address - Country:US
Mailing Address - Phone:704-527-2225
Mailing Address - Fax:704-527-2245
Practice Address - Street 1:114 FREELAND LN STE I
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1615
Practice Address - Country:US
Practice Address - Phone:704-527-2225
Practice Address - Fax:704-527-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1752111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-0883AMedicaid
NCU02211Medicare UPIN
NC2446648Medicare PIN